E1465. Oh, C!$T, What Do I Do Now?: A Case-Based Review of Adnexal Mass Management
  1. Chanel Wood; Mayo Clinic Florida
  2. Jennings Clingan; Mayo Clinic Florida
  3. Deborah Baumgarten; Mayo Clinic Florida
  4. Shweta Bhatt; Mayo Clinic Florida
  5. Candice Bolan; Mayo Clinic Florida
  6. Melanie Caserta; Mayo Clinic Florida
Ultrasound (US) is first line imaging for evaluating adnexal abnormalities and various sonographic criteria have been proposed for adnexal lesion characterization. MRI is a next step in providing further characterization of adnexal masses and can help avoid unnecessary surgery. Accurate characterization of ovarian and adnexal masses to determine risk of malignancy is necessary for optimal patient management. Several guidelines for the management of adnexal masses have been published.

Educational Goals / Teaching Points
After reviewing this case-based presentation on management of adnexal masses, the learner will: - Understand the following management guidelines: Ovarian-Adnexal Reporting and Data System (O-RADS) US Risk Stratification and Management System, updated Society of Radiologists in Ultrasound (SRU) Consensus Conference guidelines, and the International Ovarian Tumor Analysis (IOTA) group ultrasound-based simple rules - Characterize benign adnexal masses - Recognize features of adnexal masses that are suspicious for malignancy - Determine when additional imaging with MRI is appropriate

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Each of the published guidelines includes criteria for the diagnosis of characteristically benign lesions, including simple cyst, hemorrhagic cyst, endometrioma, and dermoid. This allows the radiologist increased diagnostic confidence and potentially prevents unnecessary follow-up and decreases patient anxiety. Evaluation of lesions with a less characteristic appearance, however, can yield very different follow-up recommendations. For example, a multilocular cyst can be characterized as benign without recommended follow up by IOTA criteria while meeting criteria for surgical evaluation by SRU criteria. These discrepancies offer opportunities for further investigation into the long-term outcomes of patients with indeterminate lesions managed according to each set of guidelines.

The SRU, IOTA, and O-RADS guidelines for the management of adnexal masses have the potential to spare patients with cystic lesions unnecessary anxiety and give radiologists a clear pathway for further evaluation of more indeterminate lesions. The application of these diagnostic tools requires an understanding of their content and limitations. The specific examples in this case-based review are chosen to help the learner understand how to apply the various guidelines.